S298: MATERNAL AND FETAL OUTCOMES IN PREGNANCIES OF WOMEN WITH IMMUNE THROMBOCYTOPENIA: A MULTICENTER RETROSPECTIVE OBSERVATIONAL ITP-NET ITALIAN STUDY
Authors: Monica Carpenedo, Antonella Poloni, Erika Morsia, Mattia Biondo, Giuseppina Calvaruso, Luca Frison, Livia Leuzzi, Anna Merli, Francesco Paciullo, Andrea Patriarca, Francesco Zaja, Giuseppe Carli
Journal: HemaSphere (2023)

Background: Pregnancy (P) might trigger or exacerbate a pre existing Immune thrombocytopenia (ITP). A substantial risk of maternal bleeding at delivery (D), side effects of ITP treatment (tx), thrombocytopenia of the neonate and worsening of the maternal disease lasting after D are possible consequences related to P. Specific evidence-based guidelines are lacking in this setting and the existing suggestions about management are derived from non-pregnant population. Moreover data about efficacy and safety of ITP tx are limited in P, especially for thrombopoietin receptor agonists (TPO-RA) Aims: To evaluate maternal, fetal outcomes and management strategies in women with ITP in a real world setting of 9 Italian centers (ITP-NET STUDY). Methods: Retrospective collection data from hospital charts, including platelet (plt) cut off at 1st line tx and at D, type and number of tx, treatment before D, neonatal plts at birth, maternal and neonatal adverse events. Results: We recorded data of 95 women, 93 D (2 abortion) and 96 neonates (N). 68% of women had a prior ITP diagnosis and 44% had multiple P during ITP history. 65.3% of P required first line of tx at a median g.a of 18 wks, 21% received a 2nd line of tx (median g.a of 20 wks), 8.4% received 3rd line (median g.a 29 wks). 15.5% had plt < 10 x 10 9/L at the beginning of 1st line of tx. Only one patient was already on active ITP tx with cyclosporine (CyA) before P and received steroid in addition. Diabetes and hypertension developed in 10% and 7% of pts. Bleeding recorded during P was WHO Grade 1-2 in 26.5%, and WHO 3 in 1.1%. D occurred at a median g.a of 39 wks (20-43) with a median plt count of 93 x 10 9/L (7-246). In 65.2% of P a tx has been given to reach a safe plt count for the D: 12.9% received a TPO-RA (4 Rom, 3 Eltr) as single agent or combo tx without any AEs (Table 1). Median plt count of their neonates was 67 x 10 9/L (8-161) and none of them had AEs. In 35.5% of women analgesia has been administered during labor and a cesarean section has been the choice in 31.2% of D. Peripartum bleeding occurred in 11 D(10 WHO 1-2, 1 WHO 3). 15 N (16.6%) presented thrombocytopenia at birth (12.5% < 30 x 109/L, 7.3% < 10 x 10 9/L) and 4 N reported mild bleeding (WHO 1-2). 23/81 N received an active tx, and 21 of them were given IVIG alone or combined with plt transfusion. Neonatal thrombocytopenia is related to: maternal plt count < 30 x 10 9/L at D and to maternal plt count at presentation; need of first line tx, and previous ITP tx before P (Table 2). Neonatal bleeding is only related to neonatal plt count at birth. Median maternal plt count 1 month after D was 86 x 10 9/L plt (1-562) and 17% of women showed a plt count < 30 x 10 9/L. Data on postpartum management are known only for 70 patients, of those 35 continued with the last ongoing tx a D or received a new line of tx after D included TPO-RA (16 cases alone or combo), rituximab (3) or splenectomy (2) Summary/Conclusion: Pregnancy in women with ITP occurred mostly with mild bleeding events, but a single tx agent or combo tx, including also TPO-RA are frequently needed to reach a safe plt count at D. Despite only a minority of pts having a severe thrombocytopenia at the time of labor, analgesia is used only in a small percentage of pts. Neonatal thrombocytopenia is not uncommon, is related mostly to low maternal plt count and the need of ITP tx before and during P. A multidisciplinary management of P in women with ITP is suggested especially for multirefractory pts to optimize the approach and to reduce maternal and neonatal risksKeywords: ITP, Idiopathic thombocytopenic purpura (ITP), Pregnancy